Managing Osteoporosis with an Eating Disorder

In recognition of Osteoporosis Awareness Month each November, NIED asked Dr. Debra Katzman, Professor of Pediatrics, Department of Pediatrics, University of Toronto and Senior Associate Scientist at the Research Institute, Hospital for Sick Children, Toronto, to enlighten us on a condition that can directly affect people with anorexia nervosa.

Anorexia nervosa is a life-threatening mental health disorder that has significant physical consequences. Every organ system in the body is affected. In fact, individuals with anorexia nervosa are known to have low bone density.

There are many reasons for low bone mineral density in young people with anorexia nervosa including malnutrition, low body weight, and hormonal deficiencies (i.e., estrogen and testosterone). Low bone mineral density can occur early in the course of the disorder.

Girls and boys normally increase their bone mineral density during adolescence, with approximately 90% of peak mass achieved by 18-20 years of age. Since adolescents with anorexia nervosa do not accrue bone at the same rate as young people without an Eating Disorder, they are at risk for not attaining their peak bone mass which could result in osteoporosis and fractures.

Importantly, treatments exist to help those individuals with low bone mineral density. First, it is important to diagnose low bone mineral density early. The best and safest approach to increase bone accrual and improve bone density is to regain healthy weight. This can be challenging. This healthy weight may need to be continuously readjusted in adolescents who are growing and developing.  For young adults, it is important to maintain a healthy weight. There is evidence that suggests that bone mineral density improves as weight increases, even before return of menstrual periods. Further, weight restoration should be achieved with a balanced diet rich in calcium and vitamin D intake. Sometimes young people may need calcium and vitamin D supplements. Further, avoiding smoking and alcohol can help maintain healthy bones.

If you have an Eating Disorder, your physician is the best person to diagnose and manage low bone density. Individuals with Eating Disorders should talk with their physician about having bone mineral density (BMD) test that measure their bone density. The most common test is called dual energy x-ray absorptiometry (DEXA). A DEXA is an excellent test at detecting bone loss. Finally, depending on your individual situation (i.e., age, sex at birth), your doctor may have other suggestions to help prevent bone loss.